Kelly's Blog

San Francisco public health doctors are urging patients to begin taking HIV medications soon after their diagnosis rather than waiting until their immune systems become compromised. Reports of this major policy change first surfaced last week in a New York Times article.

These new city guidelines – to be announced next week by the Department of Public Health – may be the most forceful in the world in their strong endorsement of early treatment against HIV. Doctors will offer patients combination therapy and advise them to pursue early treatment, but the patients will ultimately decide whether to begin therapy right after their diagnosis.

Antiretroviral therapy is traditionally used to stall or prevent the progression of HIV to AIDS, and it can also prevent other side effects of a degenerating immune system, like opportunistic infections and cancers. The downside is that ART can also cause liver and kidney damage among other complications.

The issue of when to begin treatment is an often discussed decision that we are asked to make with very little information on when to begin a lifetime regimen of costly and sometimes toxic medications. The answer to when remains in dispute, but San Francisco doctors are opting for treatment before permanent damage is done

Even our nation’s experts are solidly divided on the issue of when to begin treatment. In December of last year, only half of the HIV experts on the 38 member Department of Health and Human Services panel favored starting drugs in patients with healthy levels of more than 500 T-cells.

The issue for doctors and patients is whether the damage caused by HIV is more life threatening than the damage caused by some of the antiretroviral drugs. Doctors just don’t know the answer to that question right now. You can expect a great deal of discussion on that in the coming weeks and months.

We will be exploring treatment options in the next few days on our blog. Please check back for new insights on when to start treatment.